Detection of circulating free and complexed staphylococcal antigens by enzyme-linked immunosorbent assay

Detection of teichoic acid antibodies in Staphylococcus aureus infections

A commercially available agar gel diffusion (AGD) assay was used to investigate the teichoic acid antibody (TAA) response in 183 patients with proven Staphylococcus aureus (SA) infections. Two control groups were also investigated. One consisted of 100 hospitalized patients with a variety of medical and surgical conditions other than SA infection and the other consisted of 116 healthy hospital staff members. The sensitivity of the AGD assay varied markedly depending on the site of infection in the patients with proven SA infections. All patients with SA endocarditis developed positive TAA titres (greater than or equal to 1:4), although more than one third of these were initially negative. In patients with chronic osteomyelitis or septic arthritis, 41% had positive TAA titres, whereas no positive titres were detected in patients with acute osteomyelitis or septic arthritis. Lower rates of positive TAA titres were found in patients with deep abscesses (27%), pneumonia (14%) and post-operative infections (9%), but no positive titres occurred in patients with acute uncomplicated bacteremia, cellulitis or meningitis. In 100 hospitalized control patients, no positive titres were detected, and only 1 of 116 (0.9%) healthy hospital staff controls was positive. Suggested guidelines for the use of the AGD assay are discussed.

Antigen detection in the diagnosis and in the prognostic assessment of bacterial pneumonias

Sputum cultures are not helpful in the immediate management of patients with bacterial pneumonia. Sputum Gram stains may provide a presumptive identification of an etiologic agent; this procedure, however, is insensitive (approximately 50%). Consequently, during the last decade, other more sensitive and specific methods of providing a rapid etiologic diagnosis have been sought. This article discusses data on antigen detection in various body fluids by counterimmunoelectrophoresis and agglutination tests. Results from our own laboratory as well as those reported in the literature are presented. The best estimates of antigen detection rates, by the most sensitive assays, in pneumococcal pneumonia, are as follows: serum, 45%-80%; urine, 50%-64%; and sputum, 75%-100%. There is less information for Haemophilus, Klebsiella, and Pseudomonas pneumonias, but the diagnostic yield is approximately 50%-100%. Data will also be presented on the association between free and complexed antigens and morbidity and mortality in pneumococcal pneumonia. Indicators of morbidity discussed include disseminated intravascular coagulation, duration and severity of illness, and occurrence of nephritis.

A class capture enzyme immunoassay for immunoglobulin level determinations in bovine sera

An enzyme immunoassay for determination of individual isotype concentrations in bovine serum was developed. Polystyrene tubes were coated with affinity purified goat antibovine IgA, IgG1, IgG2 or IgM, washed and then incubated with purified isotypes to ascertain crossreactivity and sensitivity limits. Bound isotype was detected using the homologous affinity purified antibody conjugated to horseradish peroxidase and hydrogen peroxide-2,2-azino-di-(3-ethylbenzthiazoline sulfonic acid), as the substrate/chromogen. A standardized serum was diluted and used as a control for comparison. Several dilutions were used initially, however, determinations may be made with a single dilution, 1:200, for all isotypes. Results for 100 sera were compared to data obtained with the same samples using a radial immunodiffusion technique. A low correlation coefficient was noted between results from the two assays. Day to day variation and within test repeatability were determined for both assays using ten samples. For the enzyme immunoassay method, day to day variation for IgA, IgM, IgG1 and IgG2 determinations was 17.5, 19.3, 7.6 and 7.3% while variation in repeatability (within a test) was 6.2, 5.9, 3.3 and 4.5%, respectively. Day to day variation for the single radial immunodiffusion test for IgA, IgM, IgG1 and IgG2 was 15.4, 26.0, 11.5 and 18.3% and variation repeatability (within a test) was 11.6, 13.9, 5.9 and 8.3%, respectively. The procedures consistently detected 0.1 micrograms of immunoglobulin whereas the radial diffusion sensitivity limit was approximately 500 micrograms.

Enzyme immunoassay for the detection of group A streptococcal antigen

A competitive inhibition enzyme immunoassay for the detection of Streptococcus pyogenes directly from throat specimens or from solid bacteriological medium is described. Group A-specific polysaccharide adsorbed onto treated polystyrene beads, in conjunction with rabbit antibody to S. pyogenes, was used to determine the presence of the polysaccharide antigen. Inhibition values in excess of 65% were observed with 10(4) or more CFU of S. pyogenes per test. An inhibition of 25% was demonstrated with as few as 10(3) CFU per test. Heterologous microorganisms tested at 10(6) CFU per test reacted at levels of inhibition less than 25%. Two types of bacterial transport medium and swabs of different fiber compositions did not alter the assay performance. Accurate identification of S. pyogenes was achieved by testing single colonies picked directly from blood agar plates which had been incubated for 18 to 24 h. In addition, the assay was performed on throat specimens from children and adults having pharyngitis. A single-swab, blind study was conducted in which enzyme immunoassay reactivity was compared with results of blood agar culture and bacitracin sensitivity. When there were discordant results, serological identification was used as the confirmatory test. At an optimal cutoff value of 40% inhibition, sensitivity and specificity by enzyme immunoassay were 97.0% and 97.9%, respectively, as compared with confirmed culture results. The assay has an incubation time of 3 h and is a sensitive and specific method for the detection of S. pyogenes antigen.

Comparison of a new enzyme-linked immunosorbent assay method with counterimmunoelectrophoresis for detection of teichoic acid antibodies in sera from patients with Staphylococcus aureus infections

Ribitol-teichoic acid antibodies were measured by a new enzyme-linked immunosorbent assay (ELISA) and by counterimmunoelectrophoresis in serum samples from 47 patients with serious Staphylococcus aureus infections, 63 infected patients, and 177 healthy controls. The same antigen was used for both tests. The group of patients with S. aureus endocarditis (6 patients) had significantly higher ELISA readings than the patients with other deep-seated infections (26 patients) or with an uncomplicated S. aureus bacteremia (15 patients). The patients with other serious gram-positive (40 patients) or gram-negative (23 patients) infections did not differ from the healthy control group. There were only three (7.5%) low-level cross-reactions among the infections caused by gram-positive organisms other than S. aureus. Of 46 initially ribitol-teichoic acid antibody-negative patients followed up for 2 weeks or more, only those developing a serious S. aureus infection showed a significant rise of the ELISA reading. There was a good correlation between ELISA and counterimmunoelectrophoresis. Both tests could be useful in the diagnosis and the management of complicated S. aureus infections. The ELISA method is, however, more sensitive and usually reflects the antibody rise after an infection earlier than does counterimmunoelectrophoresis.

Serum antibodies to enterotoxins produced by Staphylococcus aureus with special reference to enterotoxin F and toxic shock syndrome

The presence of antibodies to staphylococcal enterotoxins (enterotoxins A through F) in sera of healthy subjects (n = 567) and in sera of patients with toxic shock syndrome (n = 20) was determined. Furthermore, production of enterotoxins by Staphylococcus aureus isolated from humans was investigated. In 46, 86, 78, 41, 20, and 91% of the sera of healthy subjects, antibodies were found against enterotoxins A, B, C, D, E, and F, respectively. The high percentage of sera with antibodies against enterotoxin F correlated with the relatively high frequency of enterotoxin F-producing S. aureus isolated from humans (one-third of the isolates produced enterotoxin F). In patients with toxic shock syndrome, antibodies against enterotoxin F were not present or were present only at very low levels. An increase of antibodies after onset of the disease was observed in two of eight patients investigated. From the results, it can be concluded that only those humans who show low levels of antibodies are susceptible to toxic shock syndrome.